Why head injuries need a different mindset
A head injury can look minor on the outside (a small bump) while the brain is affected on the inside (concussion or more serious injury). Your priorities are: (1) identify signs that the brain or neck may be injured, (2) keep the student safe and supervised, (3) escalate quickly when red flags appear, and (4) prevent same-day return to play/PE until cleared.
1) Mechanism-of-injury questions and immediate checks
Ask: “What happened?” (mechanism matters)
Use calm, simple questions. The goal is to estimate the force involved and whether the neck could be injured.
- Where were you hit? Front/side/back of head? Face/jaw?
- What did you hit? Ground, wall, goalpost, another student’s head/knee?
- How fast/hard? Running collision, fall from height, sports impact, thrown object?
- Did you fall after the hit? Secondary impact can worsen injury.
- Any neck pain or “crack” sensation? Treat as possible neck injury.
- Any loss of consciousness? Even brief “blackout” is important.
- Any memory gap? “Do you remember right before/after?”
Immediate checks you can do quickly
Keep the student still and supported. If the mechanism suggests possible neck injury (fall from height, high-speed collision, neck pain), minimize movement and get urgent medical help per school procedure.
- Consciousness: Are they awake? Do they respond appropriately to voice?
- Orientation: Ask name, where they are, what happened, and what class/period it is (age-appropriate). Note confusion or slow responses.
- Vomiting: Ask if they feel nauseated; watch for vomiting.
- Headache: Ask severity (mild/moderate/severe) and whether it is worsening.
- Vision/senses: Blurry/double vision, ringing in ears, sensitivity to light/noise.
- Balance: If they are already standing, note unsteadiness. Do not “test” balance aggressively.
- Behavior: Unusual irritability, emotional swings, or “not acting right.”
Quick symptom screen (use plain language)
Ask and observe:
- “Do you feel dizzy or like the room is spinning?”
- “Do you feel sleepy or like you can’t stay awake?”
- “Do you feel foggy or slowed down?”
- “Do you have trouble concentrating or remembering?”
- “Does your neck hurt?”
2) Visible injury care (bumps, minor cuts) while prioritizing neurological symptoms
Scalp bumps (“goose egg”)
- Prioritize neuro check first: If red flags are present, focus on escalation and safe positioning/supervision.
- Cold pack: Apply a cold pack wrapped in cloth for short intervals to reduce pain/swelling.
- Comfort and stillness: Encourage the student to rest quietly; avoid rushing them back to class or activity.
Minor scalp cuts
Scalp wounds can bleed a lot and look dramatic. Manage the bleeding while continuing to watch for concussion signs.
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- Control bleeding: Apply gentle, steady pressure with clean gauze/cloth. If blood soaks through, add more layers without removing the original.
- Check the wound briefly: If it is gaping, won’t stop bleeding, or you suspect embedded debris, escalate for medical evaluation.
- Do not let wound care distract you: Continue monitoring alertness, headache, nausea, and behavior.
Face impacts (nose/cheek/forehead)
- Watch for concussion symptoms: Facial injury can coincide with brain injury.
- Dental/jaw pain or bite changes: Note and report; avoid hard foods.
3) Red flags requiring emergency services
Call emergency services immediately (and follow school emergency procedures) if any of the following occur after a head injury, even if the student “seems okay” at first:
- Repeated vomiting or vomiting that begins/worsens during observation
- Seizure (jerking movements, unresponsive episode)
- Unequal pupils (one larger than the other) or new vision changes that are severe
- Severe drowsiness, difficulty staying awake, or cannot be awakened normally
- Neck pain, neck tenderness, or suspected neck injury (especially with significant mechanism)
- Confusion, disorientation, slurred speech, or unusual behavior that is new
- Worsening symptoms (headache intensifies, increasing dizziness, escalating agitation)
- Loss of consciousness (any duration) or inability to recall events around the injury
- Weakness, numbness, or trouble walking
- Persistent severe headache or “worst headache” complaint
- Bleeding or clear fluid from nose/ears after head impact
Important: If you suspect a neck injury, minimize movement. Keep the student still and supported while help is arranged.
4) Observation procedures and supervision
Do not leave the student alone
After a head impact, symptoms can evolve. Keep the student under direct supervision in a quiet, controlled environment. Avoid crowds, noise, bright lights, and physical exertion.
Set up a controlled observation space
- Position: Seated or resting comfortably. If nauseated, keep them positioned to reduce aspiration risk if vomiting occurs (per school procedure).
- Reduce stimulation: No PE, recess, sports, running, rough play, or “testing” them with challenges.
- No screens: Avoid phone/tablet/computer use during observation if concussion is suspected, as it may worsen symptoms.
- Buddy-free zone: Friends can increase stimulation and pressure to “act normal.” Keep the environment calm.
What to monitor and how often
Use consistent check-ins and document changes. A practical approach is to reassess at regular intervals (e.g., every 10–15 minutes initially, then spaced out if stable), following school policy.
- Alertness: More sleepy? Harder to engage?
- Orientation: Still knows who/where/what happened?
- Headache: Same, improving, or worsening?
- Nausea/vomiting: Any vomiting episodes? Increasing nausea?
- Balance/coordination: Any new unsteadiness when moving normally?
- Speech/behavior: Slurred speech, agitation, unusual emotionality?
- Vision: New blurriness/double vision?
If symptoms worsen during observation
Escalate immediately according to the red-flag list and school emergency procedures. Worsening over time is a key concern.
5) Communication to nurse/parents with a specific symptom list
What to report to the school nurse/health office
Give a clear, factual handoff. Use a structured message:
- Mechanism: “Ran into another student at full speed and fell backward, hitting the back of head.”
- Time of injury: Exact time and when symptoms started.
- Initial state: Awake/alert? Any loss of consciousness? Any memory gap?
- Current symptoms (checklist): headache (severity), nausea, vomiting (how many times), dizziness, confusion, sleepiness, vision changes, neck pain, balance issues, behavior changes, sensitivity to light/noise.
- Visible injuries: Bump size/location, cut/bleeding controlled, swelling.
- Trend: Improving, stable, or worsening since the incident.
- Actions taken: Cold pack, pressure for bleeding, quiet observation, emergency call if made.
What to tell parents/guardians (clear, non-alarming, specific)
Stick to observable facts and the need for medical evaluation when indicated. Example script:
Your child hit their head at [time] during [activity]. They have [bump/cut] at [location]. Since the injury, we observed: [headache level], [nausea/dizziness], [any confusion/sleepiness], and [vomiting yes/no]. Symptoms are [stable/improving/worsening]. Based on these findings and school procedure, we recommend [immediate pickup/medical evaluation/emergency services already contacted].
Provide the symptom list in writing if possible so parents can monitor at home and share with a clinician.
6) Strict boundaries on return to play/PE
No same-day return to sports or PE when concussion is suspected
If a student has any concussion-like symptoms (headache, dizziness, nausea, confusion, “foggy,” balance problems, vision changes), they should not return to play, recess sports, or PE that day. This includes “just trying a few minutes.”
Why the boundary is strict
- Symptoms can be delayed: A student may feel worse later.
- Second injury risk: Another hit before recovery can be dangerous.
- Judgment and reaction time: Concussion can impair safe participation even if the student insists they feel fine.
Return-to-activity requires policy + medical clearance
Follow your school/district policy for return-to-learn and return-to-play. Do not make “coach-style” decisions. The boundary for staff is simple: no return to PE/sports until cleared through the school’s required process (often involving healthcare provider evaluation and a stepwise progression).
Classroom activity considerations (practical boundaries)
- Reduce symptom triggers: Quiet work, reduced screen time, breaks as needed per nurse plan.
- Avoid physical exertion: No running errands, no stair sprints, no carrying heavy items.
- Watch for symptom flare: Headache or dizziness increasing with reading/screens/noise should be reported.
7) Documentation checklist (time of injury and symptom progression)
Document promptly and objectively. Avoid interpretations like “faking” or “dramatic.” Use direct quotes when helpful.
| Item | What to record |
|---|---|
| Time and location | Exact time of injury, where it occurred (playground, gym, hallway) |
| Mechanism | How it happened, what was hit, fall details, speed/height if known |
| Witnesses | Staff/student witnesses and what they observed |
| Initial symptoms | Headache, dizziness, nausea, confusion, sleepiness, vision changes, neck pain, balance issues |
| Consciousness/memory | Any loss of consciousness; any amnesia; orientation responses |
| Vomiting | Yes/no; number of episodes; times |
| Visible injuries | Bump size/location, bruising, cuts, bleeding control measures |
| Red flags | Presence/absence of key red flags; when they appeared |
| Monitoring timeline | Recheck times and symptom trend (improving/stable/worsening) |
| Actions taken | Cold pack, pressure for bleeding, rest in quiet area, supervision details |
| Escalation | Nurse notified time; parent/guardian contacted time; emergency services called time (if applicable) |
| Student statements | Quotes like “I feel foggy,” “My head is pounding,” “I can’t remember” |
| Disposition | Returned to class with restrictions, sent home, transported for evaluation (per policy) |
Practical example: symptom progression note
11:20 Injury during basketball collision; fell and hit back of head on floor. 11:22 Student alert, answers name/location correctly; reports headache 4/10 and dizziness. No vomiting. Small bump occipital area; cold pack applied. 11:35 Headache 6/10, increased light sensitivity; appears more quiet and slow to respond. Nurse notified 11:36. Parent called 11:40 for pickup and medical evaluation. No return to PE/sports.
